Vitreous visualization system and method

ABSTRACT

The present disclosure provides a vitreous visualization system including a vitreous illuminator including a vitreous visualization light source and a vitreous visualization tool that transmits lights from the vitreous visualization light source into an eye having vitreous, a pupil, and a vitreous-pupil axis. The vitreous visualization system further includes a general illuminator, which may include a general light source and a general illumination tool that transmits light from the general light source into the eye. The present disclosure further provided a vitreous visualization system including only a vitreous illuminator that transmits light from the vitreous visualization light source into an eye having vitreous, a pupil, a vitreous-pupil axis, and a retina at an angle B with the vitreous-pupil axis of the eye such that the brightness of vitreous in the eye is higher than the brightness of the retina of the eye.

TECHNICAL FIELD

The present disclosure relates to ophthalmic surgery and surgicalequipment, and more specifically, to a vitreous visualization system andmethods of vitreous visualization during ophthalmic surgery.

BACKGROUND

Ophthalmic surgery saves and improves the vision of tens of thousands ofpatients every year. However, given the sensitivity of vision to evensmall changes in the eye and the minute and delicate nature of many eyestructures, ophthalmic surgery is difficult to perform and the reductionof even minor or uncommon surgical errors or modest improvements inaccuracy of surgical techniques can make an enormous difference in thepatient's vision after the surgery.

Ophthalmic surgery is surgery performed on the eye or any part of theeye. Ophthalmic surgery is regularly performed to repair retinaldefects, repair eye muscles, remove cataracts or cancer, or to restoreor improve vision. During ophthalmic surgery, it is often useful tovisualize the vitreous, either to allow its removal or for otherreasons. The vitreous is a gel-like substance located in the eye, behindthe lens and in front of the retina, which is portion of the eye thatcontains photoreceptors sensitive to light. The vitreous is thus verytransparent and colorless to allow light to pass largely unimpeded tothe retina. The vitreous is mostly composed of water and normallycontains no blood vessels, allowing it to be transparent and colorless.Although these properties are excellent for the normal functions of thevitreous, they make it very hard to see during ophthalmic surgery.

SUMMARY

The present disclosure provides a vitreous visualization systemincluding a vitreous illuminator. The vitreous illuminator may include avitreous visualization light source and a vitreous visualization toolthat transmits lights from the vitreous visualization light source intoan eye having vitreous, a pupil, and a vitreous-pupil axis. The vitreousvisualization system further includes a general illuminator, which mayinclude a general light source and a general illumination tool thattransmits light from the general light source into the eye.

The present disclosure also provides another vitreous visualizationsystem including a vitreous illuminator. The vitreous illuminator mayinclude a vitreous visualization light source and a vitreousvisualization tool that transmits light from the vitreous visualizationlight source into an eye having vitreous, a pupil, a vitreous-pupilaxis, and a retina at an angle B with the vitreous-pupil axis of the eyesuch that the brightness of vitreous in the eye is higher than thebrightness of the retina of the eye.

Aspects of these two vitreous visualization systems and their methods ofuse may be combined with one another unless clearly mutually exclusive.In addition, the two vitreous visualization systems and their methods ofuse may include at least the following additional features, which mayalso be combined with one another unless clearly mutually exclusive: i)the system may also include a vitreous conduit that transmits light fromthe vitreous visualization light source to the vitreous visualizationtool; ii) the vitreous visualization light source may be located withinthe vitreous visualization tool; iii) the vitreous visualization lightsource may generate light at a wavelength corresponding to a visiblecolor and the general light source may generate white light; iv) thevitreous visualization light tool may transmit light into the eye at anangle of illumination A that is less than 45 degrees; v) the vitreousvisualization tool may have a numeric aperture of less than 0.30; vi)the general illumination tool may transmit light into the eye at anangle of illumination C, which is less than 75 degrees; vii) theluminous flux of the vitreous illuminator, as measured at the tip of thevitreous visualization tool, may be at least five times higher than theluminous flux of the general illuminator, as measured at the tip of thegeneral illumination tool; viii) the vitreous visualization tool maytransmit light into the eye at an angle of illumination A, and an angleB formed between the center of angle of illumination A and thevitreous-pupil axis may be less than 100 degrees; ix) the generalillumination tool may transmit light into the eye at an angle ofillumination C, and an angle D formed between the center of angle ofillumination D and the vitreous-pupil axis may be at least 90 degrees;x) the vitreous illuminator may generate pulses of light; xi) thevitreous visualization tool may have a luminous flux at its tip withinthe eye of 10 lumens or less; xii) the distance between the vitreousvisualization light source and the vitreous may be less than threemeters; xiii) the vitreous visualization tool may be combined with asurgical tool; xiv) the vitreous visualization light source and thegeneral light source may be a single combined light source; xv) thevitreous visualization tool and the general illumination tool may form acombined tool; xvi) the combined tool may include at least two opticalfibers including at least one that transmits light from the vitreousvisualization light source and at least one that transmits light fromgeneral light source; xvii) the combined tool may include a multi-coreoptical fiber having an core optical fiber that transmits light from thevitreous visualization light source and an exterior optical fiber thattransmits light from the general light source.

BRIEF DESCRIPTION OF THE DRAWINGS

For a more complete understanding of the present invention and itsfeatures and advantages, reference is now made to the followingdescription, taken in conjunction with the accompanying drawings, whichare not to scale, in which like numerals refer to like features, and inwhich:

FIG. 1 is a schematic representation of a vitreous visualization systemwith surgical instruments inserted in an eye to allow visualization ofthe vitreous during ophthalmic surgery;

FIG. 2 is a schematic representation of a vitreous visualization system,including a separate vitreous visualization tool and generalillumination tool both inserted in an eye to allow visualization of thevitreous during ophthalmic surgery;

FIG. 3 is a schematic representation of surgical instruments of anothervitreous visualization system, including a separate curved vitreousvisualization tool and general illumination tool both inserted in an eyeto allow visualization of the vitreous during ophthalmic surgery;

FIG. 4 is a schematic representation of a vitreous visualization system,including a combined vitreous visualization tool and surgical tool ageneral illumination tool inserted in an eye to allow visualization ofthe vitreous during ophthalmic surgery;

FIG. 5 is a schematic representation of a vitreous visualization system,including a vitreous visualization tool and no general illumination toolinserted in an eye to allow visualization of the vitreous duringophthalmic surgery;

FIG. 6 is a schematic representation of light from a combined vitreousvisualization tool and general illumination tool inserted in an eye toallow visualization of the vitreous during ophthalmic surgery;

FIG. 7 is a schematic representation of a vitreous visualization systemincluding a combined vitreous visualization and general illuminationtool, with surgical instruments inserted in an eye to allowvisualization of the vitreous during ophthalmic surgery;

FIG. 8 is a schematic representation of a portion of a vitreousvisualization system including a cross-section schematic representationof a combined vitreous visualization tool and general illumination tool;

FIG. 9 is a schematic representation of light cones produced by the toolof FIG. 8.

DETAILED DESCRIPTION

In the following description, details are set forth by way of example tofacilitate discussion of the disclosed subject matter. It should beapparent to a person of ordinary skill in the field, however, that thedisclosed embodiments are exemplary and not exhaustive of all possibleembodiments.

The present disclosure provides systems and methods for visualizing thevitreous during ophthalmic surgery. In particular, these systems andmethods may be used during vitreoretinal surgery and they may beespecially useful during a vitrectomy, in which all or a part of thevitreous is removed from the eye. Systems and methods of the presentdisclosure improve the ability to see the vitreous as compared tocurrent systems and methods by including a vitreous illuminator. Currentsystems and methods for visualizing the vitreous do not include aspecific vitreous illuminator. Instead, they rely on a generalilluminator, such as a system including an endoilluminator, that istypically designed to illuminate the retina or other eye structures andnot the vitreous. Such general illuminators typically provide a broadangle of illumination, whereas a vitreous illuminator as describedherein provides a focused light source, with a low angle ofillumination. In addition, a vitreous illuminator as described hereinmay provide light having other properties that facilitate visualizingthe vitreous during ophthalmic surgery, such as a particular color, alower angle of illumination, or with greater luminous flux than istypically provided by a general illuminator. Overall, the use of aseparate vitreous visualization system may allow the normally clearvitreous to have a smoky appearance, similar to normally invisible dustparticles in a laser beam or bright, focused flashlight beam.

Referring now to FIG. 1, vitreous visualization system 100 includesvitreous illuminator 110, which includes vitreous visualization lightsource 120, vitreous conduit 130, such as an optical fiber, and vitreousvisualization tool 140. Vitreous visualization light source 120generates light, which is transmitted through vitreous conduit 130 tovitreous visualization tool 140, which may be inserted into and transmitthe light into eye 300. Vitreous visualization light source 120 mayinclude any of a variety of light sources, but in particular it mayinclude a supercontinuum laser that is able to provide enough light tovitreous conduit 130 to illuminate the vitreous of eye 300. Vitreousvisualization light source may include a white light source. If thelight is a particular color, such as yellow, blue or green, vitreousvisualization light source 120 may include a monochromatic light source,such as a monochromatic laser. If vitreous visualization light source120 includes a laser, it may be any type of laser suitable to producethe selected type of light. For example, a supercontinuum laser may beused for white light. Yellow, green, and blue lasers may also be used asthese colors render the vitreous readily visible against the retina andtheir respective wavelengths are scattered well by the vitreous, alsorendering it more visible. Lasers that produce colors that are moresimilar to the retina or at wavelengths that are not scattered well bythe vitreous, such as red or orange lasers, may still be used, but theiruse may be limited to particular situations in which the color of lightconfers a different advantage.

Vitreous conduit 130 may include any material that substantiallytransmits light, but it particular, it may be an optical fiber, such asa 25 μm core fiber. Typically, if a laser and an optical fiber are used,the optical fiber is not part of the laser, which may incorporate adifferent fiber, such as a photonic crystal fiber.

Vitreous illuminator 110 may be a particularly designed instrument, butit may also be a repurposed instrument already in existence, such as alaser probe commonly used for coagulation after a vitrectomy has beenperformed. Such an instrument may be used as a vitreous illuminator 110by turning down its power.

Although vitreous visualization system 100 as illustrated in FIG. 1, hasa vitreous visualization light source 120 that is separate from vitreousvisualization tool 140, it is also possible for vitreous visualizationlight source 120 to be located in vitreous visualization tool 140, inwhich case vitreous conduit 130 may be unnecessary. One suchconfiguration is illustrated in FIGS. 7-9.

Vitreous visualization system 100 may include a number of optionaladditional components as well, some of which are also illustrated inFIG. 1. For instance, vitreous visualization system 100 may includegeneral illuminator 150, which includes general light source 160,general conduit 170, such as an optical fiber, and general illuminationtool 180, such as an endoilluminator. General light source 160 generateslight, which is transmitted by general conduit 170 to generalillumination tool 180, which may be inserted into and transmit the lightinto eye 300. General illumination light source 160 may include a laser,a white light source, or any other suitable light source.

Although vitreous visualization system 100 as illustrated in FIG. 1, hasa general light source 160 that is separate from general illuminationtool 180, it is also possible for general light source 160 to be locatedin general illumination tool 140, in which case general conduit 170 maybe unnecessary.

Vitreous visualization system 100 is depicted in FIG. 1 with separatevitreous visualization and general light sources and separate vitreousand general conduits. However, a combined light source and a partiallycombined conduit with a splitter may be used instead, particularly ifvitreous visualization tool 140 is able to focus the light and provide anarrower angle of illumination than general illumination tool 180, or ifvitreous visualization is achieved by a difference in the angles betweenvitreous visualization tool 140 and general illumination tool 180 andthe vitreous-pupil axis of eye 300 (as illustrated in FIGS. 2-5).

The portions of vitreous visualization tool 140 and general illuminationtool 180 that actually enter eye 300 may be small to avoid trauma to theeye and to allow their use with existing surgical equipment. Forinstance, they may be 20 gauge or smaller, 23 gauge or smaller, or 25gauge or smaller.

Vitreous visualization system 100 may further include a processor 190that may be in communication with and may control one or both ofvitreous illuminator 110 and general illuminator 150. For instance,processor 190 may control whether one or both of vitreous visualizationlight source 120 or general light source 160 are on or the luminous fluxor wavelengths of light one or both provide. Processor 190 may vary theon/off status or luminous flux or wavelengths of light, for example inresponse to input from controller 200, to improve visibility of thevitreous of eye 300 or to avoid phototoxicity or other negative effects.

Processor 190 may include, for example a microprocessor,microcontroller, digital signal processor (DSP), application specificintegrated circuit (ASIC), or any other digital or analog circuitryconfigured to interpret and/or execute program instructions and/orprocess data. Processor 190 may interpret and/or execute programinstructions and/or process data stored in a memory. The memory may beconfigured in part or whole as application memory, system memory, orboth. The memory may include any system, device, or apparatus configuredto hold and/or house one or more memory modules. Each memory module mayinclude any system, device or apparatus configured to retain programinstructions and/or data for a period of time (e.g., computer-readablemedia). The various servers, electronic devices, or other machinesdescribed may contain one or more similar such processors or memoriesfor storing and executing program instructions for carrying out thefunctionality of the associated machine.

Vitreous visualization system 100 may also includes a surgicalmicroscope 210, a display 220, such as a screen or head up display, orboth. Surgical microscope 210 may allow the user to view eye 300directly, or it may display an image of eye 300, such as a digital imagegenerated by processor 190 or another processor. In either case,surgical microscope 210 may display other information in addition to animage of eye 300. Such other information may be generated by processor190 or another processor and may include graphic or textual information,such as warnings, graphs, color coding, or augmented realityinformation. Display 220 may similarly display an image of eye 300generated by processor 190 or another processor and other informationgenerated by processor 190 or another processor. Such information mayinclude graphic or textual information, such as warnings, graphs, colorcoding or augmented reality information. The information displayed ondisplay 220 may not match that displayed on or seen using surgicalmicroscope 210. Controller 200 may be used to control the informationdisplayed on display 220 and surgical microscope 210.

Although one controller 200 is depicted as working through processor190, one or more controllers 200 may be directly located in vitreousilluminator 110 or general illuminator 150. For instance, a controller200 may be integrated into vitreous visualization tool 140 or generalillumination tool 180 or a combined tool as described below, where itmay control the on/off status, luminous flux, wavelength, or otherproperties of light for vitreous visualization or general illumination.A controller 200 might also be integrated into vitreous visualizationlight source 120 or general light source 160. A controller 200, even ifnot integrated into vitreous illuminator 110 or general illuminator 150,may control one of both of these without the assistance of processor190.

Processor 190 may also perform other functions relating to othercomponents of the surgery and other instruments, or relating to vitreousvisualization system 100. For example, processor 190 may track the totalamount of light output by vitreous illuminator 110 or generalilluminator 150, or both, and may provide this information to thesurgeon or even automatically adjust light output so as to not exceedpreset thresholds for total light output during a procedure or part of aprocedure or on a portion of the eye.

The brightness of the vitreous of eye 300 depends on at least fivefactors; i) the luminous flux of vitreous illuminator 110, ii) therelative luminous flux of vitreous illuminator 110 and generalilluminator 150, iii) the distance between vitreous visualization source120 and the vitreous of eye 300, iv) the angle of illumination ofvitreous visualization tool 140, and v) the angle formed between thecenter of the angle of illumination of vitreous visualization tool 140and the vitreous-pupil axis of eye 300.

The luminous flux of vitreous illuminator 110 is largely determined bythe luminous flux of vitreous visualization light source 120, which maybe controlled by processor 190 or another processor, optionally withinput from controller 200, or directly via a controller, such ascontrollers 450 and 460 in FIGS. 8 and 9. Luminous flux may be decreasedby vitreous conduit 130 and vitreous visualization tool 140, but thesecomponents are generally designed to avoid a decrease in luminous flux.The luminous flux of vitreous illuminator 110, as measured at the tip ofvitreous visualization tool 140 may be 10 lumens or less. It may also beat least 0.5 lumens, at least 1 lumen, or at least 2 lumens. Theluminous flux may also be between 0.5 lumens and 10 lumens, between 1lumen and 10 lumens, or between 2 lumens and 10 lumens. Light exitingthe tip of vitreous illuminator 110 will typically diverge less rapidlythan light exiting the tip of general illuminator 150. This leads toincreased light intensity (light per unit area).

The visibility of the vitreous is directly related to the ratio ofbrightness of the vitreous to brightness of retina. If the ratio ishigher, the vitreous is more visible. In systems with both a vitreousilluminator 110 and a general illuminator 150, the relative luminousflux of these components largely determines the ratio of brightness ofthe vitreous to brightness of the retina. The relative luminous flux ofvitreous illuminator 110 as compared to general illuminator 150 islargely determined by the relative luminous flux of vitreousvisualization light source 120 and general light source 160, one or bothof which may be controlled by processor 190 or another processor,optionally with input from controller 200, or directly via a controller,such as controllers 450 and 460 in FIGS. 8 and 9. Luminous flux may bedecreased by vitreous conduit 130, vitreous visualization tool 140,general conduit 170, and general illumination tool 180, but thesecomponents are generally designed to avoid a decrease in luminous flux.

The luminous flux of vitreous illuminator 110, as measured at the tip ofvitreous visualization tool 140, may be at least 5 times higher, atleast 10 times higher, or at least 20 times higher than the luminousflux of general illuminator 150, as measured at the tip of generalillumination tool 180. For a combined tool, the flux from vitreousilluminator components and general illuminator components may bemeasured at the tip of the combined tool and compared. Regardless ofwhether separate or combined tools are used, the general illuminatorcomponents may have a larger tip diameter, typically a fiber diameter,than the vitreous visualization components and the general illuminationlight may have a higher divergence than the vitreous visualizationlight. The ratio of the areas illuminated by the general illuminationlight as compared to the vitreous visualization light will increase asdistance from the tool tips increases. These differences in area affectthe light intensity at any region in the eye, which may be calculated orestimated in order to ensure that vitreous visualization is actuallyimproved and to avoid phototoxicity damage.

In systems with only a vitreous illuminator 110 and no generalilluminator 150, the ratio of brightness of the vitreous to brightnessof the retina may be determined by ambient light entering the eye aswell as the amount of light that reaches the retina from vitreousilluminator 110, which may be affected by a number of factors includingthe luminous flux of vitreous illuminator 110, its angle ofillumination, and its position within eye 300.

The distance between vitreous visualization light source 120 and thevitreous of eye 300 is determined largely by the length of vitreousconduit 130. Lower distances result in better visualization, so thelength of vitreous conduit 130 may be the shortest distance acceptableto allow the ophthalmic surgery to be safely performed, given theconfiguration of other equipment and surgeon preferences and parameters.Vitreous conduit 130 may be provided in different lengths. Informationregarding the length of vitreous conduit 130 may be provided toprocessor 190 or another processor controlling vitreous visualizationlight source 120 so that appropriate adjustments may be made. In generalvitreous conduit 130 may be less than three meters in length, two metersin length, or one and a half meters in length, or between any of theseendpoints.

Vitreous conduit 130 may be absent entirely in some vitreousvisualization systems, such as that described in FIG. 7-9. In suchsystems, where vitreous visualization light source 120 is located withinvitreous visualization tool 130, the distance between vitreousvisualization light source 120 and the vitreous of eye 300 is determinedlargely by the length of vitreous visualization tool 140 and theposition of vitreous visualization light source 120 within it.

The angle of illumination of vitreous visualization tool 140, indictedby angle A in FIGS. 2-5, may be less than 45 degrees, less than 35degrees, less than 30 degrees, less than 25 degrees, or less than 20degrees. In general, vitreous visualization light source 140 may focuslight and achieve a low angle of illumination A by having a numericaperture of less than 0.30, less than 0.25 less than 0.15, less than0.12, or less than 0.10 as measured in air. A small numeric aperture maybe achieved in a variety of ways. For instance, the end of a opticalfiber in vitreous visualization light source 140 may be tapered. Thismay achieve a small numeric aperture even when using an optical fiberotherwise usable in a general illumination tool. In addition an opticalfiber otherwise usable in a general illumination tool, such as onehaving a numeric aperture of 0.50 to 0.63, may be used to produce a lowangle of illumination by illuminating the optical fiber with a lightsource, such as a laser beam, that has a low numeric aperture, such asless than 0.15, less than 0.14, or less than 0.12. The light source maybe focused axially well within the optical fiber and not at the entranceface of the fiber. If the optical fiber has a tapered end proximate thelight source, then the light source may be focused past the tapered endwithin the optical fiber.

The angle between the center of angle of illumination A and thevitreous-pupil axis of eye 300, indicated as angle B in FIGS. 2-5, alsoaffects visibility of the vitreous. The vitreous is also more visible ifangel B is lower. If angle B is lower, then light from vitreousvisualization tool 140 is directed more towards the exterior of eye 300and less towards the retina. This helps avoid light from vitreousvisualization tool 140 also illuminating the retina and therebydecreasing the ratio of brightness of the vitreous to brightness of theretina. Angle B may be less than 100 degrees, less than 90 degrees, lessthan 80 degrees, or less than 60 degrees.

Angles B and D as well as the luminous flux of both vitreous illuminator110 and general illuminator 150 may change during the course of anophthalmic surgery.

If present, as shown in FIGS. 2-4, general illuminator 150 may providelight from general illumination tool 180 with a broad angle ofillumination, C, which may be at least 75 degrees, at least 80 degrees,at least 90 degrees, at least 120 degrees, at least 150 degrees, or atleast 30 degrees greater than angle A. In addition, the angle betweenthe center of angle of illumination C and the vitreous-pupil axis of eye300, indicated as angle D, may be at least 90 degrees, at least 120degrees, at least 150 degrees, at least 180 degrees, or at least 30degrees greater than angle B. Angle D may vary widely depending on thesurgical procedure. When access to peripheral areas of the eye isneeded, the eye may be rotated significantly a general illumination tool180 may be moved to a large angle D.

In addition to the factors discussed above, visibility of the vitreousmay be improved by differences in the wavelengths of light provided byvitreous visualization light source 120 and general light source 160.For instance general light source 160 may provide white light, whilevitreous visualization light source 120 may provide green light, such asdescribed in further detail in FIGS. 7-10. In general, light havingshorter wavelengths, such as green or blue, scatters better in thevitreous than light having longer wavelengths, such as red. Accordingly,shorter wavelength light may better facilitate vitreous visualization.In addition, red and orange light, due to their similarities to retinacolor, may not improve vitreous visualization as much as colors lesssimilar to retina color. However, shorter wavelengths of light may bemore likely to cause accidental damage to the eye, such as a, hakichazard such that very short wavelengths may not be used, even if theyprovide more improvements in vitreous visualization. In general, lightfrom vitreous visualization light source may have a wavelength in therange of 480-530 nm (aqua to green-yellow). Wavelengths in the range of510-530 nm may be used to take advantage of readily available greendiodes, such as green diodes that produce light in the 510-520 nm range.

Further, vitreous illuminator 110 may provide light in a flashing orpulsing pattern to further enhance visibility of the vitreous,particularly when general illuminator 150 provides white light. Theflashing or pulsing pattern may be controlled by processor 190 oranother processor and may be started or stopped or otherwise controlledby controller 200.

Referring now to FIG. 2, a portion of vitreous visualization system 100a is shown inserted in eye 300 during ophthalmic surgery. Both vitreousvisualization tool 140 a and general illumination tool 180 are insertedinto vitreous 310 of eye 300. Eye 300 has a vitreous-pupil axis 320,that is determined with respect to pupil 330.

Vitreous visualization tool 140 provides light with a low angle ofillumination, A, the center of which forms angle B with vitreous-pupilaxis 320. General illumination tool 180 provides light with a broadangle of illumination, C, the center of which forms angle D withvitreous-pupil axis 320. Angles B and D are such that generalillumination tool 180 tends to illuminate the retina 340, while vitreousvisualization tool 140 a tends to illuminate the vitreous 310.

One or more additional surgical tools, such as vitrectomy probe 350, mayalso be inserted into eye 300. Improved visualization of vitreous 310may allow such additional surgical tools to be used more safely orefficiently.

In order to further increase angle B, vitreous visualization system 100b may include vitreous visualization tool 140 b, which is curved asshown in FIG. 3 so that its tip may be oriented more in the direction ofpupil 330 and less in the direction of retina 340 when it is inserted ineye 300. The angle and dimensions of the curve of vitreous visualizationtool 140 b may be determined by the optical properties of its componentmaterials, such as an optical fiber, as well as the need to be able toinsert it into eye 300 without undue damage. For instance, the curve mayhave a bend angle of between 35 and 45 degrees.

As shown in FIG. 4, vitreous visualization system 100 c may include acombined vitreous visualization tool/surgical tool 140 c. In the exampleshown, the surgical tool portion of combined vitreous visualizationtool/surgical tool 140 c is a vitrectomy probe, but combinations withother surgical tools, such as an infusion cannula, are also possible.Depending on the surgical tool, vitreous visualization tool/surgicaltool 140 c may remain largely in place or it may be moved frequentlyduring the ophthalmic surgery. Due to the combination with a surgicaltool, vitreous visualization tool/surgical tool 140 c may reduce traumato eye 300 by allowing one fewer incision in the eye. The same is truefor other combined tools 140.

As described above with respect to FIG. 1, some vitreous visualizationsystems, such as vitreous visualization system 100 d of FIG. 5, mayinclude only vitreous illuminator 110, such that only vitreousvisualization tool 140 d is inserted in eye 300, with no generalillumination tool. This configuration may provide a very high ratio ofbrightness of the vitreous 310 to brightness of the retina 340. Inaddition, when separate vitreous visualization is no longer needed, forexample after completion of a vitrectomy, vitreous visualization tool140 d may then instead be used as a general illumination tool.Adjustments to the light provided, its angle with the vitreous-retinaaxis, and other parameters may be performed at that time.

Although FIGS. 2-5 illustrate one vitreous illuminator 110 with onevitreous visualization tool 140 and one general illuminator 150 with onegeneral illumination tool 180, if present, multiple instances ofilluminators and tools maybe used. In addition, features of the variousfigures may be combined or duplicated without departing from theprinciples of this disclosure. For example, a combination vitreousvisualization tool/surgical tool 140 c such as that illustrated in FIG.4 may be used as the sole vitreous visualization tool 140 d in FIG. 5,or in combination with an additional straight or curved vitreousvisualization tool 140 a or 140 b from FIGS. 2 and 3, respectively.Similarly, both straight and curved vitreous visualization tools 140 aand 140 b from FIGS. 2 and 3, respectively, may be used in combination.Although vitreous illuminator 110 is shown with one vitreousvisualization tool 140 in FIG. 1, multiple vitreous visualization tools140 may actually be combined with the same vitreous illuminator 110.

When more than one vitreous visualization tool 140 is present in eye300, they may be used in different ways, such as at different angels Bwith the vitreous-pupil axis 320, with different angles of illuminationA, or to provide different wavelengths of light or luminous flux.

Furthermore, vitreous visualization system 100 may have a singlecombined vitreous visualization and general illumination tool 140 e,which may be inserted in eye 300 in a manner similar to combinedvitreous visualization tool/surgical tool 140 c of FIG. 4. Asillustrated in FIG. 6, such a combined tool may provide a low angle ofillumination A of more intense or different wavelengths of light forvitreous visualization and a broad angle of illumination C of lessintense or white light for general illumination.

Such combined vitreous visualization and general illumination tools 140e may have a dual-fiber configuration, such as the use of two opticalfibers in the same tool, or the use of a multi-core optical fiber. Lightfor vitreous visualization may be supplied to one optical fiber, such asthe core optical fiber of a multi-core optical fiber, while light forgeneral illumination may be supplied to another optical fiber such as anexterior optical fiber of a multi-core optical fiber.

For instance, combined vitreous visualization and general illuminationtool 140 e may include a core fiber that is single mode and has adiameter of between 15 μm and 25 μm, such as 20 μm. The core fiber maybe surrounded by an exterior fiber with a diameter of between 100 μm and500 μm, such as 400 μm. The numeric aperture of such a multi-core fibermay be determined by cladding surrounding it, an external medium, orboth.

Another multi-core fiber might use a high-index core fiber, such a fiberwith an index of up to 1.7, or between 1.40 and 1.55, such as between1.45 and 1.52 in the visible light range with a slightly lower-indexexternal fiber. The index difference between the fibers controls thenumeric aperture of the fiber, with a smaller different resulting inlower numeric aperture. The high-index core fiber may have a smallnumeric aperture, such as less than 1 or less than 0.12 while thelower-index external fiber may have a higher numeric aperture, such asgreater than 0.20 or greater than 0.25. Such an optical fiber may beused with a single light source. The ratio of light delivered to thecore fiber versus the external fiber may be controlled by the ratio ofnumeric apertures, by the spot and spot size of where the light entersthe core, or any combination thereof.

A combined vitreous visualization and general illumination tool 140 emay also include a single optical fiber, such as a standard generalillumination fiber, that transmits light for vitreous visualization andlight for general illumination. For instance, a laser may provide lightfor vitreous visualization while a white light source may provide lightfor general illumination. A dichroic filter may combine the laser lightwith the white light to form a collimated beam, which may then passthrough a condensor, so that both light from the laser and light fromthe white light source for general illumination are coaxial and focusedinto the optical fiber of the combined vitreous visualization andgeneral illumination tool 140 e.

In a specific vitreous visualization system 100 e, depicted in FIG. 7, acombined vitreous visualization and general illumination tool 140 f isprovided. Tool 140 f includes vitreous visualization light source 120.Tool 140 f is also a component of general illuminator 150, which alsoincludes general light source 160 and general conduit 170, thattransmits light from general light source 160 to tool 140 f. Optionalcomponents 190, 200, 210, and 220 of vitreous visualization system 100 emay be as described with respect to FIG. 1.

As illustrated in FIG. 9, general conduit 170 may include cable 400,which includes a conduit portion of a general illumination opticalfiber, with connector 410 at one end, which may be plugged into generallight source 160 to allow transmission of light through general conduit170. Connector 410 may be a fiber optic ACMI connector.

The other end of cable 400 attaches to combined vitreous visualizationand general illumination tool 140 f at conduit attachment 420 so thatlight transmitted through cable 400 may enter tool 140 f As describedfurther with respect to FIG. 9, the general illumination optical fiber500 in cable 400 may have a tool portion that passes through conduitattachment 420, tool housing 430, and probe tip 440, where it may enterthe eye if probe tip 440 is inserted in the eye.

Light for vitreous visualization is generated within tool 140 f and mayalso pass through probe tip 440 and into the eye, if probe tip 440 isinserted in the eye. Light for vitreous visualization may be turned onor off with control 450, which may be a simple on/off switch (not shown)or a combined on/off and luminous flux control switch, such as theswitch depicted in which and up/down movement turns light for vitreousvisualization on or off, while rolling the wheel controls luminous flux.Levers and pressure sensors may also be used in a combined or separateluminous flux control (not shown).

Control 450 may be electrically connected to laser 460 via circuit 470,such as the flexible circuit depicted. Laser 460 may include a diodelaser or other laser. It may further include a circuit board and amicroprocessor, as shown. Alternatively, laser 460 may be controlled byan external processor which may be connected to control 450 or anothercontrol.

Combined vitreous visualization and general illumination tool 140 f mayinclude an internal power source, such as a battery 480, which mayprovide a 6V direct current or a direct current less than 6V. Theinternal power source may provide energy to laser 460 as well as anycomponent circuit board or microprocessor. Power may alternatively beprovided by an external source.

Laser 460 may produce light having a particular wavelength, such aswavelengths in the green spectrum of visible light, or tool 140 f maycontain a dichoric filter so that only a particular wavelength of entersvitreous visualization optical fiber 480. Laser 460 may, in particular,be a Class 2 green diode laser that produces light with a wavelength inthe range of 510-520 nm. In order to avoid phototoxicity or othernegative effects, laser 460 may have a luminous flux of 6 mW or lower.Further, laser 460 may regulate its luminous flux using photodiodes andhardware loops. These features may be arranged such that laser 460always turns on at its lowest luminous flux, further avoidingphototoxicity or other negative effects.

A light beam from laser 460 is transmitted to vitreous visualizationoptical fiber 480, which transmits the light through probe tip 440 so itmay exit combined vitreous visualization and general illumination tool140 f After leaving laser 460 and prior to entering optical fiber 480,the light beam may pass through one or ore optical components, which mayalter the light beam. As illustrated in FIG. 9, the light beam firstpasses through collimator 490, then through condenser 510 beforeentering optical fiber 480.

General illumination optical fiber 500 runs from conduit attachment 420,through housing 430, and joins vitreous visualization optical fiber 480in probe tip 440. Probe tip 440 may include a thin tube, such as a metaltube, that surrounds general illumination optical fiber 500 and vitreousvisualization optical fiber 480.

The relative size and numeric aperture of general illumination opticalfiber 500 and vitreous visualization optical fiber 480 control theirangles of illumination, A and C, which determine the light coneprojected from the fibers. As shown in FIG. 9, when viewed at an axialdistance of 10 mm, angle of illumination A may produce light cone 600,while angle of illumination C may produce light cone 610. Light cone 610may have a diameter two to three times larger than that of light cone600. In addition, light cone 610 may be white, while light cone 600 maybe green or another color produced by laser 460 or resulting from adichoric filter in tool 140 f.

Combined vitreous visualization tool 140 f and vitreous visualizationsystem 100 e and components thereof may be combined with other elementsof vitreous visualization tools and systems described herein unlessclearly mutually exclusive. For instance the laser and generalillumination light sources in vitreous visualization system 100 e may beused with other vitreous visualization systems described herein.

The present disclosure further includes a method of illuminating thevitreous of the eye, for instance during ophthalmic surgery such asvitreoretinal surgery and particularly during a vitrectomy. In themethod, a vitreous illuminator such as described herein is used asdescribed herein to illuminate to the vitreous of the eye to allow itsvisualization. In particular, the vitreous illuminator may provide lightwith an angle of illumination, at an angle with the vitreous-pupil axis,with a luminous flux, in a pulsed pattern, or at a wavelength thatfacilitates vitreous visualization. The vitreous, thus rendered visible,may then be removed using a vitrectomy probe. Alternatively, it may beavoided and not removed if desired during the surgery. Once the need tovisualize the vitreous has passed, the vitreous illuminator may beswitched off or used for another purpose or removed from the eye toprotect against phototoxicity or to allow the insertion of otherinstruments.

The above disclosed subject matter is to be considered illustrative, andnot restrictive, and the appended claims are intended to cover all suchmodifications, enhancements, and other embodiments which fall within thetrue spirit and scope of the present disclosure. For example, althoughvitreous visualization is most commonly needed during ophthalmicsurgery, if it were useful in another procedure, such as a purelydiagnostic procedure not otherwise considered to be surgery, the systemsand methods described herein may be employed.

The invention claimed is:
 1. A vitreous visualization system comprising:a vitreous illuminator comprising: a vitreous visualization lightsource; and a vitreous visualization tool that is configured to transmitlight from the vitreous visualization light source into an eye havingvitreous, a pupil, and a vitreous-pupil axis; a general illuminatorcomprising: a general light source; and a general illumination tool thatis configured to transmit light from the general light source into theeye; wherein the vitreous visualization tool and the generalillumination tool form a combined tool; wherein the combined toolcomprises a multi-core optical fiber having a core optical fiber thattransmits light from the vitreous visualization light source and anexterior optical fiber that transmits light from the general lightsource.
 2. The vitreous visualization system of claim 1, furthercomprising a vitreous conduit that transmits light from the vitreousvisualization light source to the vitreous visualization tool.
 3. Thevitreous visualization system of claim 1, wherein the vitreousvisualization light source is located within the vitreous visualizationtool.
 4. The vitreous visualization system of claim 1, wherein thevitreous visualization light source generates light at a wavelengthcorresponding to a visible color and the general light source generateswhite light.
 5. The vitreous visualization system of claim 1, whereinthe vitreous visualization light tool is configured to transmit lightinto the eye at an angle of illumination A that is less than 45 degrees.6. The vitreous visualization system of claim 1, wherein the vitreousvisualization tool has a numeric aperture of less than 0.30.
 7. Thevitreous visualization system of claim 1, wherein the generalillumination tool is configured to transmit light into the eye at anangle of illumination C, which is less than 75 degrees.
 8. The vitreousvisualization system of claim 1, wherein a luminous flux of the vitreousilluminator, as measured at a tip of the vitreous visualization tool, isat least five times higher than a luminous flux of the generalilluminator, as measured at a tip of the general illumination tool. 9.The vitreous visualization system of claim 1, wherein the vitreousvisualization tool is configured to transmit light into the eye at anangle of illumination A, and wherein an angle B formed between a centerof angle of illumination A and the vitreous-pupil axis is less than 100degrees.
 10. The vitreous visualization system of claim 1, wherein thegeneral illumination tool is configured to transmit light into the eyeat an angle of illumination C, and wherein an angle D formed between acenter of angle of illumination D and the vitreous-pupil axis is atleast 90 degrees.
 11. The vitreous visualization system of claim 10,wherein the vitreous visualization tool is configured to transmit lightinto the eye at an angle of illumination A, and wherein an angle Bformed between a center of angle of illumination A and thevitreous-pupil axis is less than 100 degrees.
 12. The vitreousvisualization system of claim 1, wherein the vitreous illuminatorgenerates pulses of light.
 13. The vitreous visualization system ofclaim 1, wherein the vitreous visualization tool is configured to have aluminous flux at its tip within the eye of 10 lumens or less.
 14. Thevitreous visualization system of claim 1, wherein a distance between thevitreous visualization light source and the vitreous is configured to beless than three meters.
 15. The vitreous visualization system of claim1, wherein the vitreous visualization tool is combined with a surgicaltool.
 16. The vitreous visualization system of claim 1, wherein thevitreous visualization light source and the general light source are asingle combined light source.
 17. The vitreous visualization system ofclaim 1, wherein the vitreous visualization light source is amonochromatic laser and the general light source is a white lightsource.
 18. The vitreous visualization system of claim 1, wherein thevitreous visualization light source is a monochromatic laser and thegeneral light source is a supercontinuum laser.
 19. A vitreousvisualization system comprising a vitreous illuminator comprising: avitreous visualization light source; and a vitreous visualization toolthat is configured to transmit light from the vitreous visualizationlight source into an eye having vitreous, a pupil, a vitreous-pupilaxis, and a retina at an angle B with the vitreous-pupil axis of the eyesuch that a brightness of the vitreous in the eye is higher than abrightness of the retina of the eye; a general illuminator comprising: ageneral light source; and a general illumination tool that is configuredto transmit light from the general light source into the eye; whereinthe vitreous visualization tool and the general illumination tool form acombined tool; wherein the combined tool comprises a single opticalfiber that transmits both the light from the vitreous visualizationlight source and the light from the general light source; wherein thevitreous visualization light source is a monochromatic laser and thegeneral light source is a white light source and wherein a dichroicfilter combines the laser light from the vitreous visualization lightsource and the white light from the white light source to form acollimated beam to place on the single optical fiber of the combinedtool.
 20. The vitreous visualization system of claim 19, furthercomprising a vitreous conduit that transmits light from the vitreousvisualization light source to the vitreous visualization tool.
 21. Thevitreous visualization system of claim 19, wherein the vitreousvisualization light source is located within the vitreous visualizationtool.
 22. The vitreous visualization system of claim 19, wherein thevitreous visualization light tool transmits light into the eye at anangle of illumination A that is less than 45 degrees.
 23. The vitreousvisualization system of claim 19, wherein the vitreous visualizationtool has a numeric aperture of less than 0.30.